Anemic Drugs

Question 1

conditions associated with normocytic, microcytic, and macrocytic RBCs

Answer 1

normocytic RBC - acute blood loss
microcytic - iron deficiency anemia
macrocytic - B12 or folic acid deficiency

Question 2

causes of iron deficiency

Answer 2

acute or chronic blood loss
insufficient intake esp in kids
heavily menstruating or preggo women

Question 3

type of anemia from iron deficiency

Answer 3

hypochromic, microcytic anemia

Question 4

oral iron therapy

Answer 4

ferrous sulfate
ferrous gluconate
ferrous fumurate

Question 5

adverse effects of oral iron therapy

Answer 5

nausea
epigastric discomfort
abdominal cramps
constipation
diarrhea

black stool (no significance other than may obscure diagnosis of continued GI blood loss)

Question 6

what are parenteral iron therapy and when is it given

Answer 6

iron dextran, sodium ferric gluconate complex, iron sucrose

given to those who are unable to absorb or tolerate oral iron and extensive chronic anemia that cannot be maintained with oral iron alone

Question 7

when is acute iron toxicity usually seen

Answer 7

in children who accidentally swallow iron tablets and it is a medical emergency

Question 8

what do kids with acute iron toxicity experience as in what are their symptoms

Answer 8

necrotizing gastreoenteritis, vomiting, abdominal pain, blood diarrhea

can be followed by shock, metabolic acidosis, coma, and death

Question 9

how do you treat acute iron toxicity

Answer 9

• whole bowel irrigation to flush out iron
• Deferoxamine, an iron chelator, can systemically bind iron that has already been absorbed and get rid of it in urine or feces

Question 10

another name for chronic iron toxicity and what is it

Answer 10

hemachromatosis and when excessive iron is deposited in the heart, liver, pancreas, and other organs

Question 11

who is hemachromatosis mainly seen in

Answer 11

pts with inherited hemachromatosis

those who receive many red cell transfusions

Question 12

drugs used in pts with thalassemia major to get rid of iron

Answer 12

iron chelators - deferoxamine and deferasirox

Question 13

what does deficiency in vit B12 lead to

Answer 13

megaloblastic anemia

neurological symptoms

Question 14

active form of vit B12 found in humans

Answer 14

deoxyadenosylcobalamin and methylcobalamin

Question 15

forms of vit b12 found in foods that are converted to active form

Answer 15

cyanocobalamin, hydroxycobalamin, and other cobalamins

Question 16

how long will it take to use up our storage of vit b12

Answer 16

5 years

Question 17

relationship between vitamin B12 and folate

Answer 17

methylcobalamin (from vit B12) is an intermediate in transfer of methyl group from N5-methyltetrahydrofolate to homocysteine in order to form methionine and tetrahydrofolate (dTMP)

without vit B12, you have a build up of homocysteine and lack of tetrahydrofolate (needed for DNA synthesis)

called methylfolate trap

Question 18

what happens when you have lack of tetrahydrofolate due to lack of Vit B12 and what is treatment

Answer 18

• lack of tetrahydrofolate means reduced DNA synthesis

- give folic acid to tx the anemia

Question 19

what leads to neurological symptoms in vit B12 deficiency

Answer 19

vit b12 is needed to convert methylmalonyl CoA to succinyl coA by methylmalonyl coA mutase so without it, you have a build up of methylmalonyl coA which accumulates as methymalonic acid which causes neurological problems

Question 20

characteristic manifestation of Vit B12 deficiency

Answer 20

• megaloblastic, macrocytic anemia
• mild or moderate leukopenia/thrombocytopenia
• hypercellular bone marrow
• accumulation of megaloblastic erythroids
• parasthesia in peripheral nerves
• ataxia and other CNS problems

Question 21

if megaloblastic anemia is diagnosed, why must it be determined if it is due to vit B12 or folic acid deficiency

Answer 21

• treating with folic acid will reverse the hematological problems but the neurological symptoms of vit B12 will continue to get more severe

Question 22

common causes of vit b12 deficiency

Answer 22

• pernicious anemia (no secretion of intrinsic factor by gastric mucosal cells)
• partial or total gastrectomy
• conditions that affect distal ileum

Question 23

what are the parenteral injections given for vit b12 deficiency and for how long

Answer 23

cyanocobalamin and hydroxocobalamin

for life if due to pernicious anemia especially

Question 24

drugs that cause folate acid deficiency

Answer 24

methotrexate
phenytoin
trimethoprim and pyrimethamine

Question 25

high risk patients that require folate supplementation

Answer 25

pregnant women
alcoholics
hemolytic anemia
liver disease
certain skin disease
pts on renal dialysis

Question 26

what are the hematopoietic growth factors

Answer 26

FrIEDS
Filgastrim
Interleukin 11
Erythropoietin
Darbepoetin
Sargramostim

Question 27

where is endogenous erythropoietin produced and what happens with it during tissue hypoxia

Answer 27

• produced in the kidney

- increased transcription of erythropoietin in response to hypoxia hence correcting anemia

Question 28

relationship between hematocrit/hemoglobin levels and erythropoietin normally and in anemia of chronic renal failure

Answer 28

• normally if hematocrit or hemoglobin levels are high then erythropoietin levels are low and vice versa
• in those with anemia of chronic renal failure, erythropoietin levels are usually low because kidney is not able to produce it so they benefit from exogenous erythropoietin

Question 29

what is darbepoetin and how does it differ from erythropoietin

Answer 29

long acting version of erythropoietin that differs by an addition of two carb chain which improves it biological activity

it has decreased clearance and half life that is three times that of erythropoietin

Question 30

adverse effects of erythropoietin

Answer 30

hypertension

thrombotic complications

Question 31

what are the growth factors and what do they do

Answer 31

filgastrim (G-CSF –> granulocyte colony stimulating factor)
sargramostim (GM-CSF –> granulocyte-macrophage colony stimulating factor)

they both stimulate the production and function of neutrophils

GM-CSF stimulates production of myeloid and other megakaryocyte progenitors

Question 32

have receptors that are part of JAK-STAT pathway

Answer 32

erythropoietin
filgastrim
sargramostim

Question 33

what is filgastrim and sargramostim used for

Answer 33

accelerate recovery of neutrophil after cancer therapy and to treat other form of neutropenia

Question 34

what is erythropoietin used for

Answer 34

anemia in renal failure but also anemia of other forms

Question 35

adverse effects of filgastrim and sagrasmostim

Answer 35

G-CSF - bone pain

GM-CSF - fever, arthralgias, capillary damage with edema

Question 36

what does interleukin-11 do and what is it used to treat

Answer 36

stimulates growth of primitive megakaryocyte progenitors and increase number of peripheral platelets

used for patients with prior episodes of thrombocytopenia after a cycle of cancer chemo so they don’t have to get platelet transfusions

Question 37

used to treat sickle cell anemia

Answer 37

hydroxyurea

Question 38

what does hydroxyurea do

Answer 38

it increases the amount of fetal hemoglobin therefore diluting the amount of abnormal hemoglobin S (HbS)

Question 39

side effects of hydroxyurea

Answer 39

bone marrow suppression and cutaneous vasculitis

Question 40

what is hydroxyurea used to treat other than sickle cell

Answer 40

chronic myelogenous leukemia (CML)

polycythemia vera